How does Service 1st Benefits support my business during open enrollment?

We personally manage the entire open enrollment process — from educating employees to handling enrollment forms and answering plan questions. Our goal is to make open enrollment smooth and stress-free for everyone.

Can employees contact you directly for help?

Yes. Employees can reach out to us anytime for questions about claims, coverage, ID cards, or plan details. We act as your team’s benefits partner, not just your broker.

What size businesses do you work with?

We specialize in serving small and medium-sized businesses, typically ranging from 1–200 employees. If you’re growing or planning to expand, we help scale your benefits as your team grows.

Do you handle communication with insurance carriers for us?

Absolutely. We take care of claims issues, employee changes, renewals, and any carrier communication so you don’t have to spend hours on hold.

Do you offer voluntary or supplemental benefits?

Yes. We can provide optional add-ons like disability, accident, or critical illness insurance to enhance your benefits package at little or no cost to the employer.

What types of group benefits do you offer?

We provide comprehensive group health, dental, vision, and life insurance options for small and medium-sized businesses. We help you compare plans, handle enrollment, and manage carrier communication.

What information do you need to provide a quote?

We typically need: Number of employees Basic employee census (age, gender, ZIP code) Current plan (if applicable) Desired benefits or coverage goals We keep the process as simple as possible.

Do you charge fees for your services?

No. Our services — including plan comparison, open enrollment, and year-round support — are provided at no additional cost to your business.

Prescription Drug Tiers Explained: Why Your Copay Changes by Medication

Service 1st Benefits

Oct 15

2 min read

Two prescriptions, two completely different copays — and it's not random. Here's what's actually driving the difference.

What a Formulary Actually Is

A formulary is your plan's list of covered medications, organized into cost tiers. The tier a specific drug falls into — not just whether it's covered at all — is what determines what you actually pay at the pharmacy counter.

The Tier Structure, Bottom to Top

Most formularies use three or four tiers, though some go up to six. Tier 1 is typically generic drugs, with the lowest copay. Tier 2 is usually preferred brand-name drugs — often ones without a generic equivalent yet. Tier 3 is non-preferred brand-name drugs, which usually cost more specifically because a generic or preferred alternative already exists. Tier 4 (and sometimes 5) is reserved for specialty drugs — high-cost biologics and injectables used for complex conditions like cancer or autoimmune disease.

Copay vs. Coinsurance

Lower tiers usually charge a flat copay — the same dollar amount every time, regardless of the drug's actual price. Higher tiers, especially specialty tiers, often switch to coinsurance instead — a percentage of the drug's cost, which means the price swings with what the medication itself actually costs.

Why the Same Condition Can Cost Differently Depending on the Drug

Two people being treated for the same condition can end up on completely different tiers, and therefore completely different costs, depending on which specific medication their doctor prescribes. A generic option and its brand-name equivalent can treat the same thing — one on Tier 1, the other on Tier 3 — with a real cost gap between them for functionally similar treatment.

What to Actually Do

Before assuming a prescription's cost, check where it falls on your plan's formulary. If a medication lands on a higher tier, it's worth asking your doctor or pharmacist whether a lower-tier generic or preferred alternative treats the same condition — sometimes it does, and the cost difference can be significant for comparable treatment.

Final Thoughts

Your copay isn't set by your condition — it's set by which specific medication you're prescribed and where that drug sits on your plan's formulary. Knowing the tier structure is what turns "why is this so expensive" into an actual answer you can act on.